Efficiency, Innovation, and Sustainability in Healthcare Systems

Background: This study examined shifts in the productivity and efficiency of Opioid Substitution Treatment (OST) units in Greece from 2019 to 2022. OST units address withdrawal symptoms in individuals discontinuing psychoactive substances. They also offer mental health care, primary healthcare, psychosocial support, and other integrated services, aiming to provide holistic addiction treatment and promote social reintegration. Methods: We assessed the contributions of 54 OST units addressing opioid addiction using non-parametric Malmquist Data Envelopment Analysis (DEA). Data were collected from all OST units operating in Greece during this period, with a focus on key external factors such as the COVID-19 pandemic and rising global trends in stimulant and synthetic opioid use. Results: The analysis revealed a productivity decline in 2020, followed by improvements in the next two years. However, technical efficiency declined, suggesting a decrease in resource utilization. Conclusions: This dip in efficiency likely reflects the impact of emerging drug trends, particularly stimulants and synthetic opioids, which lack standardized treatment protocols. These findings highlight the urgent need for new treatment options to address evolving addiction trends. The study also underscored the need for improved data collection and monitoring to optimize resource allocation and enhance operational efficiency in OST units. Strengthening evidence-based policies and expanding access with low-threshold treatment services could improve patient outcomes and the overall effectiveness of OST programs. Full article

Background: Hospital infrastructures account for a significant portion of healthcare expenditures, yet the factors driving facility management costs (FMCs) remain underexplored, particularly in the Italian context. This study aims to analyze FMCs in hospitals, focusing on utility and maintenance expenses, while providing benchmarking values to support decision making. Methods: This study employed a mixed-methods approach, integrating a literature review, financial data analysis, and a case study of 27 hospital facilities in Lombardy. Data on utility and maintenance costs were collected from financial statements and supplemented with targeted questionnaires to enhance precision. Descriptive statistics and parametric cost indicators (e.g., EUR/sqm, EUR/bed) were analyzed to identify trends and disparities. Results: FMC increased by an average of 32.90% between 2019 and 2022, with utility expenses constituting 77.45% of total costs and maintenance accounting for 22.45%. Utility costs rose significantly (37.34%), driven by energy and cleaning services, while maintenance costs grew more moderately (18.66%). Cost variability was evident across hospital typologies, with Basic Healthcare Centers averaging 122.86 EUR/sqm compared to 232.66 EUR/sqm for Level II Emergency Hospitals. Conclusions: This study highlights significant variability in FMCs across Italian hospitals and underscores the need for benchmarking to optimize resource allocation. Future research should expand the dataset, incorporating extraordinary maintenance costs, and examine management models to enhance cost efficiency. These findings provide actionable insights for policymakers and healthcare administrators to improve hospital infrastructure sustainability and efficiency. Full article

Background/Objectives: The COVID-19 pandemic has significantly altered healthcare systems worldwide, highlighting healthcare expenditure’s critical role in fostering population resilience and wellness. This extraordinary situation has brought to light the delicate balance that governments must maintain between the need to protect public health and budgetary restraints. The relationship between healthcare expenditure and outcomes, such as healthy life years, health expectancy, and standardized death rate, has become a central point in understanding the dynamics of healthcare systems and their capacity to adapt to emerging challenges. Methods: Using extensive datasets and predictive approaches such as artificial neural networks, exponential smoothing models, and ARIMA techniques, this study explores these connections in the context of the European Union. Results: The study better explains how healthcare financing schemes influence important health outcomes by examining past trends and forecasting future developments. The results show that household healthcare expenditures correlate negatively with standardized death rates and substantially benefit healthy life years and health expectancy. These findings underline the significance of household contributions in influencing health outcomes across various healthcare systems. Long-term and strategic investments in health services are essential, as the pandemic has demonstrated the proactive capacity of well-designed healthcare systems to reduce risks and enhance overall resilience. The results suggest that focused investments can raise life expectancy and lower death rates, supporting the development of robust, adaptable healthcare systems in the post-pandemic era. Conclusions: The main contribution of this research is demonstrating the significant role of healthcare expenditure, particularly household contributions, in improving key health outcomes and fostering healthcare system resilience in the EU context. Full article

Background: Climate change poses significant challenges to global health, At the same time, the healthcare sector itself, with its high resource demands, also contributes substantially to global warming. Anesthesia, particularly through the use of volatile inhalation anesthetics, is a key contributor in this respect. The present exploratory study examines staff perceptions of precycling and recycling strategies aimed at reducing the environmental impact of anesthetic gases at the General Hospital Vienna, Austria. This large institution has recently implemented major changes, including the shutdown of the centralized nitrous oxide supply and the introduction of anesthetic gas recycling systems on anesthesia machines, alongside other precycling measures. Methods: We conducted a cross-sectional online survey of anesthesia team members (n = 103, 61.2% females) to assess current perceptions related to anesthetic gas usage, focusing on precycling and recycling aspects, and their willingness to engage in further sustainability efforts. Results: We found that participants expressed an, in general, positive attitude towards environmental protection measures and a high willingness to make additional efforts to recycle anesthetics. Thus, the anesthesia team members in our institution may be inclined to support strategies like minimizing the use of volatile anesthetics. Conclusions: These preliminary insights could inform actionable recommendations for advancing sustainable practices in anesthesiology at our hospital. Full article

Background/Objectives: In recent years, knowledge management and digital innovation have become pivotal in transforming healthcare systems, driving efficiency and enhancing patient outcomes. This study presents a bibliometric analysis of research trends at the intersection of knowledge management and digital innovation in healthcare, examining the scope, impact, and evolution of scholarly work in this domain. Methods: Using a comprehensive dataset from the Scopus database, we analyzed 419 publications from 1985–2023 to identify influential authors, journal collaborations, and emerging topics and methodologies in the field. Results: Our findings reveal a significant increase in research interest, highlighting themes such as data-driven healthcare, artificial intelligence in clinical decision support, and knowledge-sharing platforms’ role in improving healthcare delivery. The analysis also underscores the growing importance of interdisciplinary collaboration between healthcare providers, technologists, and policy-makers. Conclusions: By mapping the intellectual structure of knowledge management and digital innovation in healthcare, this study provides valuable insights for academics, practitioners, and policy-makers seeking to harness knowledge management practices and digital technologies to foster innovation and resilience in healthcare systems. Full article

Aim: Electronic prescribing has allowed for the collection of prescription data in real time in Greece for the first time. Hence, the aim of the current study was to present the characteristics of prescriptions for the Greek population during the period from 2015 to 2021. Methods: This retrospective study was based on data extracted from the nationwide Greek electronic prescription database between January 2015 and December 2021. Descriptive statistics methods were used for the needs of the study. As the basic figures examined depend on the size of the population, in order for the results to be comparable, we estimated the corresponding measures per inhabitant, using population data from the Greek Statistical Authority. Appropriate indicators for the comparison of consumption and expenditure over time were estimated. A study of the trend was also carried out using time series and linear regression models. In order to facilitate the design and implementation of specialized policies, it is useful to identify the drug categories with the highest consumption and expenditure, as well as the geographical areas that present similar characteristics. For the first, ABC analysis was used, which helps to identify the most popular categories of drugs, while for the second, cluster analysis was carried out. Agglomerative clustering was used to divide the regions into similar groups. This hierarchical clustering algorithm classifies the population into several clusters, with areas in the same cluster being more similar, and areas in different clusters being dissimilar. The Ward linkage method with Euclidean distance was used. Results: The analysis of prescription drug consumption and expenditure from 2015 to 2021 revealed significant fluctuations and trends across various drug categories, age groups, and geographical areas. Notably, the quantity of prescriptions increased by 20% since 2015, while expenditure surged by over 30%, with significant spikes following the end of the MoU in 2019 and the onset of the pandemic in 2020. In terms of expenditure, antineoplastic and immunomodulation agents (category L) held the largest share, driven by the introduction of new, costly drugs. The expenditure per inhabitant revealed gender and age disparities, with older populations, particularly women, incurring higher costs. Geographically, drug expenditure, and consumption varied significantly, with distinct regional clusters identified. These clusters, while showing some overlap in consumption and expenditure patterns, also highlighted unique regional characteristics. Conclusions: The insights into prescription drug consumption and expenditure trends offer a valuable basis for developing targeted interventions aimed at optimizing healthcare resource allocation. Moreover, the findings underscore the importance of addressing regional and demographic disparities in pharmaceutical use, thereby contributing to more equitable and cost-effective healthcare strategies. More specifically, the age distribution of prescriptions shows the increase in younger ages, which, as a result, anticipates the overall increase in prescriptions. The knowledge of the most convex categories of medicine, as well as the percentages of the use of generic drugs, shows where interventions should be made, with financial incentives and information through new information channels. The geographic disparities recorded should lead to policies that help the residents of hard-to-reach areas to access prescriptions. In addition, the present study provides a strategic framework for policymakers and healthcare managers to guide future studies and inform decision-making processes. Full article

Strengthening primary healthcare (PHC) is vital for enhancing efficiency and improving access, clinical outcomes, and population well-being. The World Health Organization emphasizes the role of effective PHC in reducing healthcare costs and boosting productivity. With growing healthcare demands and limited resources, efficient management is critical. Background/Objectives: Building on this point, this study aimed to evaluate the efficiency of PHC units across Greece, focusing on Health Centers (HCs) and Local Health Units (ToMYs). The objective was to assess their efficiency levels and identify factors contributing to observed inefficiencies. This study explores a novel research area by being the first to assess the efficiency of restructured primary healthcare facilities in Greece, utilizing 2019 data—the first year operational data became available for the newly established ToMY facilities following recent healthcare reforms. Methods: We applied a comprehensive suite of non-parametric methods, including Data Envelopment Analysis (DEA) under variable, constant, increasing, and decreasing returns to scale (VRS, CRS, IRS/NDRS, DRS/NIRS) assumptions, along with the Free Disposal Hull (FDH) model, all oriented toward output maximization. Efficiency scores were refined using bootstrapping to calculate 95% confidence intervals, and efficient units were ranked via the super-efficiency model. Outliers were identified and removed through the data cloud algorithm. For the first time at this scale, the final sample included the vast majority of PHC facilities in Greece—234 Health Centers and 94 Local Health Units—with inputs categorized into three human resource types: medical, nursing/paramedical, and administrative/other staff. Outputs encompassed scheduled visits, emergency visits, and pharmaceutical prescription visits. This diverse and comprehensive application of DEA methods represents a novel approach to evaluating PHC efficiency in Greece, with potential relevance to broader healthcare contexts. Results: The analysis revealed significant inefficiencies and differences in technical efficiency between HCs and ToMYs. HCs could nearly double their outputs (VRS score: 1.92), while ToMYs could increase theirs by 58% (VRS score: 1.58). Scale efficiency scores were closer, with HCs slightly more aligned with their optimal scale (1.17 vs. 1.20 for ToMYs). Conclusions: There is significant potential to improve efficiency in PHC, with variations depending on unit characteristics and regional differences. This evaluation provides a foundation for policymakers to identify areas for improvement and enhance the overall performance of healthcare services in Greece. Full article

The purpose of this study is to evaluate and illustrate the effectiveness of a specialized digital platform developed to improve the accuracy of medical coding during the full implementation of Greece’s new DRG system, and to highlight innovative actions for achieving and/or improving accurate medical coding. Already grouped DRG cases recorded in the first DRG implementation year in the region of Crete were examined. A sample of 133,922 cases was analyzed and audited, through a process consisting of three stages: (i) digitalization, (ii) auditor training, and (iii) control and consultation. The results indicated that a significant proportion of DRG coding, with a length of stay exceeding one day, was reclassified into different DRG categories. This reclassification was primarily due to coding errors—such as the omission of secondary diagnoses, exclusion of necessary medical procedures, and the use of less specific codes—rather than mistakes in selecting the principal diagnosis. The study underscores the importance of medical coding control and consulting services. It demonstrates that targeted actions in these areas can significantly enhance the implementation of the DRG coding system. Accurate medical coding is crucial for transparent allocation of resources within hospitals, ensuring that hospital services and reimbursements are appropriately managed and allocated based on the true complexity and needs of patient cases. Full article

Background: Sustainability in healthcare has gained increasing importance due to its impact on environmental, financial, and social strategies, as well as on public health, and therefore, relevant policies and actions can also play a significant role in telemedicine services. The establishment of a sustainable telemedicine network at a country level is important to improve access to healthcare, reduce costs, increase convenience, and ensure the continuity of service delivery. However, there are significant environmental, social, technological, human, and governance challenges to meet the sustainability conditions for these networks. Methods: Thus, a narrative literature review was conducted to investigate the telemedicine implementation aspects and the sustainability dimensions in a unified approach and integrated strategy in order to develop a more resilient and equitable healthcare solution, ensuring its long-term integration into healthcare systems. Results: This paper aims to identify critical factors related to the proposed governance model for the National Telemedicine Network in Greece (EDIT) that influence sustainability requirements and interdisciplinary strategies to address relevant challenges. Conclusions: By examining these factors, the paper seeks to propose the fundamental pillars of a sustainable telemedicine framework and the methodology for developing a sustainability plan that will enhance EDIT’s capacities toward a sustainable and resilient operation of telemedicine as a standard practice within the Greek healthcare system. Full article